{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T08:47:06Z","timestamp":1791967626779,"version":"4.3.4"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2024,6,22]],"date-time":"2024-06-22T00:00:00Z","timestamp":1719014400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,6,22]],"date-time":"2024-06-22T00:00:00Z","timestamp":1719014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Radiol"],"abstract":"Abstract<\/jats:title>\n \n Objectives<\/jats:title>\n To assess 3-Tesla (3-T) ultra-small superparamagnetic iron oxide (USPIO)-enhanced MRI in detecting lymph node (LN) metastases for resectable adenocarcinomas of the pancreas, duodenum, or periampullary region in a node-to-node validation against histopathology.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Twenty-seven consecutive patients with a resectable pancreatic, duodenal, or periampullary adenocarcinoma were enrolled in this prospective single expert centre study. Ferumoxtran-10-enhanced 3-T MRI was performed pre-surgery. LNs found on MRI were scored for suspicion of metastasis by two expert radiologists using a dedicated scoring system. Node-to-node matching from in vivo MRI to histopathology was performed using a post-operative ex vivo 7-T MRI of the resection specimen. Sensitivity and specificity were calculated using crosstabs.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Eighteen out of 27 patients (median age 65 years, 11 men) were included in the final analysis (pre-surgery withdrawal\n n<\/jats:italic>\n \u2009=\u20094, not resected because of unexpected metastases peroperatively\n n<\/jats:italic>\n \u2009=\u20092, and excluded because of inadequate contrast-agent uptake\n n<\/jats:italic>\n \u2009=\u20093). On MRI 453 LNs with a median size of 4.0\u2009mm were detected, of which 58 (13%) were classified as suspicious. At histopathology 385 LNs with a median size of 5.0\u2009mm were found, of which 45 (12%) were metastatic. For 55 LNs node-to-node matching was possible. Analysis of these 55 matched LNs, resulted in a sensitivity and specificity of 83% (95% CI: 36\u2013100%) and 92% (95% CI: 80\u201398%), respectively.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n USPIO-enhanced MRI is a promising technique to preoperatively detect and localise LN metastases in patients with pancreatic, duodenal, or periampullary adenocarcinoma.<\/jats:p>\n <\/jats:sec>\n \n Clinical relevance statement<\/jats:title>\n Detection of (distant) LN metastases with USPIO-enhanced MRI could be used to determine a personalised treatment strategy that could involve neoadjuvant or palliative chemotherapy, guided resection of distant LNs, or targeted radiotherapy.<\/jats:p>\n <\/jats:sec>\n \n Registration<\/jats:title>\n \n The study was registered on clinicaltrials.gov NCT04311047.\n https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04311047?term=lymph+node&cond=Pancreatic+Cancer&cntry=NL&draw=2&rank=1<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Key Points<\/jats:title>\n \n \n \n \n LN metastases of pancreatic, duodenal, or periampullary adenocarcinoma cannot be reliably detected with current imaging<\/jats:italic>\n .\n <\/jats:p>\n <\/jats:list-item>\n \n \n This technique detected LN metastases with a sensitivity and specificity of 83% and 92%, respectively<\/jats:italic>\n .\n <\/jats:p>\n <\/jats:list-item>\n \n \n MRI with ferumoxtran-10 is a promising technique to improve preoperative staging in these cancers<\/jats:italic>\n .\n <\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1007\/s00330-024-10838-w","type":"journal-article","created":{"date-parts":[[2024,6,22]],"date-time":"2024-06-22T10:01:31Z","timestamp":1719050491000},"page":"7973-7984","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Ferumoxtran-10-enhanced MRI for pre-operative metastatic lymph node detection in pancreatic, duodenal, or periampullary adenocarcinoma"],"prefix":"10.1007","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0436-9804","authenticated-orcid":false,"given":"Geke","family":"Litjens","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsushi","family":"Nakamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lodewijk A. 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The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}},{"value":"No complex statistical methods were necessary for this paper.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was obtained from all subjects (patients) in this study.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained from the Medical Research Ethics Committee Oost-Nederland.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"No study subjects or cohorts have been previously reported.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}